The Gender Gap In Pain

After two years of convincing doctors to investigate my unrelenting pelvic pain, in July of last year, I was diagnosed with the autoimmune condition, Inflammatory Bowel Disease.

As my doctor wrote out a script for my medication, I cried strange tears of joy, because I was no longer the girl who cried pain.

We know that the gender gap permeates into many different facets of women’s lives. Arenas of contention still exist in the pay cheques we receive, the boardrooms we sit in, and the streets we walk down. But, often less spoken about, is the gap that exists in the diagnosis and treatment of a woman’s illness.

I first felt this disparity in the emergency room of a Sydney hospital. The tired-eyed intern came to my bed and with a questioning face, gently probed, “are you sure the pain is a nine? You seem fine, and you’re smiling, so I can’t imagine that you have appendicitis.” (It’s worth noting that I was encouraged to rush to the emergency department after an ultrasound indicated that I did have appendicitis.)

I wish I could tell him that for the last three months I have lived at the mercy of random bouts of pain that bring me to my knees, and only with a careful concoction of painkillers, chocolate and this “smile” I can hide the toll it takes on my body and my mind.

I wish I could tell him that I have seen three doctors, in the past three months, and watched their eyes glaze over when they see me cry. The next questions will be targeted towards depression—which is not entirely invalid, but either is the stabbing pain they seem to gloss over so easily.

Clenching the bleached sheets between my fingers, I take deep breaths begging my tear ducts to abstain from crying. I recite my rehearsed script, listing the symptoms slowly and with no emotion.

After nearly sending me home and delaying surgery because “I was still smiling”, my protest was heard and I was taken into surgery where they found an almost-burst appendix. I was hospitalised for seven days.

The Pain Bias

While there has been widespread anecdotal account about the pain bias that lives within the healthcare system for decades, more recently, studies have given a voice to these stories.

A study published by the Society for Academic Emergency Medicine found that when men and women both presented to emergency rooms with abdominal pain, women were still 13 to 25 percent less likely than men to receive high-strength “opioid” pain medication. And waited an average of 16 minutes longer to receive them.

Recently, the University of Gothenburg reviewed 77 articles about the influence gender has on a patient’s experience with doctors. The study found that women are compared to men in regards to pain. This separation is not based on biological differences, but gendered norms—men being stoic and unemotional, and women to be sensitive and dramatic. Despite women having more pain, and dominating chronic pain syndromes. This dangerous measuring stick led to women’s pain being underexplored and perceived as a psychological issue.

Sydney based, General Practice Registrar, Prasanthi Purusothaman, who is undertaking her final year of study, is clear when asked about the pain bias: “There is a lot of stereotyping around women and pain, and in my experience as both a female and a doctor, pain bias is real.”

Dr. Purusothaman believes that there are several contributing factors to this disparity. “Historically, the medical profession was largely male-dominated and I feel that this can at times inform a lot of bias towards female patients seeking medical attention for women’s health-related issues.”

This observation is also supported by the author of Doing Harm, Maya Dusenbery, who recently pointed out to Refinery 29 that since women are relatively new additions to the medical profession, they have been unable to represent themselves. “Until the 1970s, there were essentially no women involved in medical practice or research,” says Dusenbery.

A lack of female presence in the medical arena has also meant that there was a dangerous diagnosis given to those who presented to doctors with unexplained symptoms: Hysteria.

During the 20th century, hysteria was seen as a valid mental disorder for unexplained symptoms and this diagnosis was only discredited by psychiatrists in 1980. Like many discriminatory beliefs that have taken place throughout history, these labels can live under the surface of society long after they are disputed.

The Cost Of Pain

Closer to home, in Australia, I came to learn that many women suffer from undiagnosed pelvic pain. Currently, one in five women in Australia experience pelvic pain and one in ten women suffer from endometriosis. If we widen our lens, to an economic view, endometriosis costs Australia $7.7 billion a year. So, not only does this cost women their quality of life but also affects our economy.

This statistic finally became too significant to be ignored and in March of last year, it was revealed that the government will be provide funding $2.5 million for the improvement in diagnosis and treatment for women with the disease.

While a simple conclusion would be to blame doctor incompetence as the deciding factor of diagnostic and treatment delays, from a doctor’s point of view, the fast-paced nature of the society we live in, and our desire for instant answers (even I consider Google my first port of call) has made it hard for doctors to educate the community on the reality of diagnostic delays when it comes to more complex health issues, particularly in women.

“I do think it is important for the public to also (within reason) trust the opinion of their health professionals and understand in the absence of red flags, there is often a systematic stepwise approach,” says Dr. Purusothaman.

As a gynecologist, Dr. Gino Pecaroro knows this frustration all too well. “Pelvic pain in women is a complex beast. We know that as many as 20% of women suffer from endometriosis and that the average time from symptom expression to diagnosis remains at around seven years.”

After several ultrasounds, blood tests, MRI scans, colonoscopies, and ‘exploratory’ keyhole surgeries, my persistence paid off. I was given a diagnosis, pain management plan, and the right medication. Within two weeks my inflammation was completely gone, and for the first time in over a year I was able to get out of bed easily, exercise, and stay awake past 9 p.m. I started to remember who I was prior to the “intruder in my body” as it came to be known.

Both Dr. Pecaroro and Dr. Purusothaman believe continued education and a patient’s self-willed quest for answers is the way forward to combatting the gender bias. “The solution would always involve education for the health workforce… as well as patients becoming more vocal in requesting analgesia [pain relief]” says Dr. Pecaroro.

The tendency to doubt women’s pain (whether it’s conscious or not) is connected to larger cultural and social stigmas that are attached to us like sticky tape—just think of how many times you’ve heard a woman be called “hysterical.” In a doctor’s mind, for a split second, there is an option to see us as emotional or over-reporting our symptoms, and this choice plays out in how we are treated.

While I often feel paralyzed by the choicelessness that comes with living with a chronic illness, I have learned to find power in my gut-instinct and seek answers with unwavering tenacity. I have learned that my body is the vessel that will steer me towards the professional and personal success I desire, and thus it is paramount that I fight for it.